Novel Colorimetric and Light Scatter Methods to Identify and Manage Peritoneal Dialysis-Associated Peritonitis at the Point-of-Care.

Introduction: Peritoneal dialysis (PD)-related peritonitis (PDRP) is a common cause of transfer to hemodialysis, patient morbidity, and is a risk factor for mortality. Associated patient anxiety can deter selection of PD for renal replacement therapy. Diagnosis relies on hospital laboratory tests; however, this might be achieved earlier if such information was available at the point-of-care (POC), thereby significantly improving outcomes. The presence of culturable microbes and the concentration of leukocytes in effluent both aid peritonitis diagnosis, as specified in the International Society for Peritoneal Dialysis (ISPD) diagnostic guidelines. Here, we report the development of 2 new methods providing such information in simple POC tests. Methods: One approach uses a tetrazolium-based chemical reporting system, primarily focused on detecting bacterial contamination and associated vancomycin-sensitivity. The second approach uses a novel forward light-scatter device (QuickCheck) to provide an instant quantitative cell count directly from PD patient effluent. Results: The tetrazolium approach detected and correctly distinguished laboratory isolates, taking 10 hours to provide non-quantitative results. We compared the technical performance of the light scatter leukocyte counting approach with spectrophotometry, hemocytometer counting and flow cytometry (Sysmex) using patient effluent samples. QuickCheck had high accuracy (94%) and was the most precise (coefficient of variation <4%), showing minimal bias, overall performing similarly to flow cytometry. Conclusion: These complementary new approaches provide a simple means to obtain information to assist diagnosis at the POC. The first provides antibiotic sensitivity following 10 hours incubation, whereas the second optical approach (QuickCheck), provides instant accurate total leukocyte count.

Peritoneal Dialysis Care for People with Diabetes, Polycystic Kidney Disease, or Advanced Liver Disease.

People treated with peritoneal dialysis (PD) often have complicating conditions that require careful management. Three such conditions are reviewed in this article-diabetes mellitus, polycystic kidney disease, and chronic liver disease. Each of these conditions requires an understanding of both its effect on the delivery of the PD and the effect of the PD on the condition itself. In diabetes, glucose absorption from the dialysate complicates metabolic control and affects salt and water management and patient outcome. There is particular benefit in clinical care being delivered through a multidisciplinary team that involves both kidney and diabetes experts. In relation to polycystic kidney disease, a key issue is the potential for increased intraperitoneal pressure due to the combined effect of the enlarged polycystic organs and the presence of the dialysis solution, and therefore, the PD prescription requires to be managed with a particular focus on limiting that pressure. For patients with liver disease, key issues include nutritional support because PD can add to protein losses already consequent on the liver disease itself. Considered approaches are required to manage ascites and reduce infection risk and the potential for hernias and leaks to develop. Mortality in this group is unfortunately high-however, PD may present a better management option than hemodialysis in many patients-particularly in those where the liver disease is complicated by low BP, clotting abnormalities, or troublesome ascites. Overall, the choice to use PD in patients with these complicating conditions should be based on shared decision making with the patient and their family members informed by high-quality information in which risks, benefits, and management strategies are clearly presented.

Real-World Performance of Large Vessel Occlusion Artificial Intelligence-Based Computer-Aided Triage and Notification Algorithms-What the Stroke Team Needs to Know.

PURPOSE: To evaluate the real-world performance of two FDA-approved artificial intelligence (AI)-based computer-aided triage and notification (CADt) detection devices and compare them with the manufacturer-reported performance testing in the instructions for use. MATERIALS AND METHODS: Clinical performance of two FDA-cleared CADt large-vessel occlusion (LVO) devices was retrospectively evaluated at two separate stroke centers. Consecutive "code stroke" CT angiography examinations were included and assessed for patient demographics, scanner manufacturer, presence or absence of CADt result, CADt result, and LVO in the internal carotid artery (ICA), horizontal middle cerebral artery (MCA) segment (M1), Sylvian MCA segments after the bifurcation (M2), precommunicating part of cerebral artery, postcommunicating part of the cerebral artery, vertebral artery, basilar artery vessel segments. The original radiology report served as the reference standard, and a study radiologist extracted the above data elements from the imaging examination and radiology report. RESULTS: At hospital A, the CADt algorithm manufacturer reports assessment of intracranial ICA and MCA with sensitivity of 97% and specificity of 95.6%. Real-world performance of 704 cases included 79 in which no CADt result was available. Sensitivity and specificity in ICA and M1 segments were 85.3% and 91.9%. Sensitivity decreased to 68.5% when M2 segments were included and to 59.9% when all proximal vessel segments were included. At hospital B the CADt algorithm manufacturer reports sensitivity of 87.8% and specificity of 89.6%, without specifying the vessel segments. Real-world performance of 642 cases included 20 cases in which no CADt result was available. Sensitivity and specificity in ICA and M1 segments were 90.7% and 97.9%. Sensitivity decreased to 76.4% when M2 segments were included and to 59.4% when all proximal vessel segments are included. DISCUSSION: Real-world testing of two CADt LVO detection algorithms identified gaps in the detection and communication of potentially treatable LVOs when considering vessels beyond the intracranial ICA and M1 segments and in cases with absent and uninterpretable data.

Virtual Poverty Simulation: Effect on Attitudes Toward Poverty in Nursing Students.

BACKGROUND: Simulation has been shown to be an effective teaching strategy for increasing nursing students' knowledge and empathy toward individuals with low income. Virtual simulation is effective in teaching critical thinking, situational awareness, and empathy. METHOD: This mixed-method study examined three virtual poverty simulation programs. The study sample included senior baccalaureate nursing students (n = 99) in a Community Health course. RESULTS: Fifteen of the 21 items on the Attitudes Toward Poverty-Short Form (ATP-SF) scale showed a statistically significant increase in knowledge and understanding of people living in poverty. Qualitative data analysis revealed four themes: (1) empathy; (2) sacrifice; (3) stress; and (4) moral struggle. CONCLUSION: Virtual poverty simulation is a teaching strategy for increasing nursing students' empathy, knowledge, and understanding of those living in poverty to provide compassionate, culturally competent care for individuals with low income. The simulation can be implemented in a variety of settings. [J Nurs Educ. 2023;62(11):642-646.].

Student and faculty perceptions of effectiveness of online teaching modalities.

BACKGROUND: When the COVID-19 pandemic forced colleges and universities to rapidly transition from face-to-face teaching to online teaching/learning environments, different instructional methods were employed to deliver course content and help students remain engaged in learning. With the transition back to the on-campus environment, select online teaching modalities may be effective in the face-to-face environment as well. While online and distance learning have been extensively studied, little research is available to guide faculty in using technologies designed for distance learning in the face-to face environment. PURPOSE: The purpose of this study was to determine pre-licensure baccalaureate nursing student and nursing faculty perceptions of the effectiveness of various online teaching modalities. METHOD: A mixed-methods study using a convenience sample of students and faculty at two universities was conducted. Students and faculty completed a researcher-developed survey to rate a variety of online teaching methods and technologies from a scale of one (not effective at all) through six (extremely effective). Participants also provided comments within the survey and in focus groups of randomly selected students and faculty. Surveyed items included modes of asynchronous and synchronous instruction, instructional technology, and instructional activities. RESULTS: There were significant differences as well as similarities in student and faculty perceptions of effectiveness. Students demonstrated a clear preference for pre-recorded lectures, while faculty perceived synchronous lectures and assigned readings to be equally as effective as pre-recorded lectures. Synchronous activities such as case studies and student presentations were rated as more effective by faculty than by students. Both groups perceived instructional games, especially quiz games, as very or extremely effective. CONCLUSIONS: Students were more engaged with instructional activities that they perceived as effective for learning. The results of this study will assist faculty in developing effective online and in-person instruction which will optimize the teaching/learning experience.

Development and Implementation of a Multisite Registry Using Structured Templates for Actionable Findings in the Kidney.

PURPOSE: The aim of this study was to scale structured report templates categorizing actionable renal findings across health systems and create a centralized registry of patient and report data. METHODS: In January 2017, three academic radiology departments agreed to prospectively include identical structured templates categorizing the malignant likelihood of renal findings in ≥90% of all adult ultrasound, MRI, and CT reports, a new approach for two sites. Between November 20, 2017, and September 30, 2019, deidentified HL7 report data were transmitted to a centralized ACR registry. An automated algorithm extracted categories. Radiologists were requested to addend reports with missing or incomplete templates after the first month. Separately, each site submitted patient sociodemographic and clinical data 12 months before and at least 3 months after enrollment. RESULTS: A total of 164,982 eligible radiology reports were transmitted to the registry; 4,159 (2.5%) were excluded because of missing categories or radiologist names. The final cohort included 160,823 examinations on 102,619 unique patients. Mean template use before and after addendum requests was 99.3% and 99.9% at SITE1, 86.5% and 94.6% at SITE2, and 91.4% and 96.0% at SITE3. Matching patient sociodemographic and clinical data were obtained on 96.9% of reports from SITE1, 94.2% from SITE2, and 96.0% from SITE3. Regulatory, cultural, and technology barriers to the creation of a multisite registry were identified. CONCLUSIONS: Barriers to the adoption of unified structured report templates for actionable kidney findings can be addressed. Deidentified report and patient data can be securely transmitted to an external registry. These data can facilitate the collection of diverse evidence-based population imaging outcomes.

Comparison of Thyroid Risk Categorization Systems and Fine-Needle Aspiration Recommendations in a Multi-Institutional Thyroid Ultrasound Registry.

OBJECTIVES: The aim of this study was to compare how often fine-needle aspiration (FNA) would be recommended for nodules in unselected, low-risk adult patients referred for sonographic evaluation of thyroid nodules by ACR Thyroid Imaging Reporting and Data System (TI-RADS), the American Thyroid Association guidelines (ATA), Korean Thyroid Imaging Reporting and Data System (K-TIRADS), European Thyroid Imaging Reporting and Data System (EU-TIRADS), and Artificial Intelligence Thyroid Imaging Reporting and Data System (AI-TIRADS). METHODS: Seven practices prospectively submitted thyroid ultrasound reports on adult patients to the ACR Thyroid Imaging Research Registry between October 2018 and March 2020. Data were collected about the sonographic features of each nodule using a structured reporting template with fields for the five ACR TI-RADS ultrasound categories plus maximum nodule size. The nodules were also retrospectively categorized according to criteria from ACR TI-RADS, the ATA, K-TIRADS, EU-TIRADS, and AI-TIRADS to compare FNA recommendation rates. RESULTS: For 27,933 nodules in 12,208 patients, ACR TI-RADS recommended FNA for 8,128 nodules (29.1%, 95% confidence interval [CI] 0.286-0.296). The ATA guidelines, EU-TIRADS, K-TIRADS, and AI-TIRADS would have recommended FNA for 16,385 (58.7%, 95% CI 0.581-0.592), 10,854 (38.9%, 95% CI 0.383-0.394), 15,917 (57.0%, 95% CI 0.564-0.576), and 7,342 (26.3%, 95% CI 0.258-0.268) nodules, respectively. Recommendation for FNA on TR3 and TR4 nodules was lowest for ACR TI-RADS at 18% and 30%, respectively. ACR TI-RADS categorized more nodules as TR2, which does not require FNA. At the high suspicion level, the FNA rate was similar for all guidelines at 68.7% to 75.5%. CONCLUSION: ACR TI-RADS recommends 25% to 50% fewer biopsies compared with ATA, EU-TIRADS, and K-TIRADS because of differences in size thresholds and criteria for risk levels.

The Effect of a Lifestyle Intervention on Weight Loss for University Employees.

Obesity is a major health issue. A community-based intervention was implemented on a college campus to help employees lose body weight and fat. Participants were scanned using the InBody device at pre- and post-intervention, measuring body weight, fat, and waist circumference. Participants attended 11 classes on healthy lifestyle education. A comparison of pre- and post-intervention measurements was made using a paired t-test, resulting in a statistically significant difference in outcome measures. Correlation between class attendance and pounds lost showed a moderate negative correlation. Findings support a community-based lifestyle behavior intervention for weight and fat loss for university employees.

JOURNAL CLUB: Computer-Aided Detection of Lung Nodules on CT With a Computerized Pulmonary Vessel Suppressed Function.

OBJECTIVE: The purpose of this study is to evaluate radiologists' performance in detecting actionable nodules on chest CT when aided by a pulmonary vessel image-suppressed function and a computer-aided detection (CADe) system. MATERIALS AND METHODS: A novel computerized pulmonary vessel image-suppressed function with a built-in CADe (VIS/CADe) system was developed to assist radiologists in interpreting thoracic CT images. Twelve radiologists participated in a comparative study without and with the VIS/CADe using 324 cases (involving 95 cancers and 83 benign nodules). The ratio of nodule-free cases to cases with nodules was 2:1 in the study. Localization ROC (LROC) methods were used for analysis. RESULTS: In a stand-alone test, the VIS/CADe system detected 89.5% and 82.0% of malignant nodules and all nodules no smaller than 5 mm, respectively. The false-positive rate per CT study was 0.58. For the reader study, the mean area under the LROC curve (LROCAUC) for the detection of lung cancer significantly increased from 0.633 when unaided by VIS/CADe to 0.773 when aided by VIS/CADe (p < 0.01). For the detection of all clinically actionable nodules, the mean LROC-AUC significantly increased from 0.584 when unaided by VIS/CADe to 0.692 when detection was aided by VIS/CADe (p < 0.01). Radiologists detected 80.0% of cancers with VIS/CADe versus 64.45% of cancers unaided (p < 0.01); specificity decreased from 89.9% to 84.4% (p < 0.01). Radiologist interpretation time significantly decreased by 26%. CONCLUSION: The VIS/CADe system significantly increased radiologists' detection of cancers and actionable nodules with somewhat lower specificity. With use of the VIS/CADe system, radiologists increased their interpretation speed by a factor of approximately one-fourth. Our study suggests that the technique has the potential to assist radiologists in the detection of additional actionable nodules on thoracic CT.

p21Cip1/WAF1 mediates cyclin B1 degradation in response to DNA damage.

p21(Cip1/WAF1) is the principle mediator of cell cycle arrest in response to DNA damage. p21 primarily mediates G(1) cell cycle arrest by inactivating G(1)-associated cyclin A- and cyclin E-containing cyclin/cdk complexes. In the present study we investigate the role of p21 in DNA damage-induced G(2) cell cycle arrest, particularly with respect to the G(2)-associated cyclin, cyclin B1. We demonstrate that cells lacking p21 or deficient in their ability to upregulate p21 are unable to mediate the downregulation of cyclin B1 in response to DNA damage as compared to wild-type cells. Decreased levels of cyclin B1 in response to DNA damage seen in wild-type cells is due to p21-mediated degradation of cyclin B1 as this can be inhibited by a proteasomal inhibitor. Cell cycle analysis reveals that p21-null cells are unable sustain G(2) cell cycle arrest and accumulate at greater than 4N DNA content. These results indicate that p21-mediated degradation of cyclin B1 in response to DNA damage is necessary for the maintenance of G(2) cell cycle arrest.

Chromium-mediated apoptosis: involvement of DNA-dependent protein kinase (DNA-PK) and differential induction of p53 target genes.

Cellular stress and DNA damage up-regulate and activate p53, fundamental for cell cycle control, senescence, DNA repair and apoptosis. The specific mechanism(s) that determine whether p53-dependent cell cycle arrest or p53-dependent apoptosis prevails in response to specific DNA damage are poorly understood. In this study, we investigated two types of DNA damage, chromium treatment and gamma irradiation (IR) that induced similar levels of p53, but that mediated two distinct p53-dependent cell fates. Chromium exposure induced a robust DNA-dependent protein kinase (DNA-PK)-mediated apoptotic response that was accompanied by the rapid loss of the cyclin-dependent kinase inhibitor 1A (p21) protein, whereas IR treatment-induced cell cycle arrests that was supported by the rapid induction of p21. Inhibition of DNA-PK effectively blocked chromium-, but not IR-induced p53 stabilization and activation. In contrast, inhibition of ATM and ATR by caffeine had the inverse effect of blocking IR-, but not chromium-induced p53 stabilization and activation. Chromium exposure ablated p21 transcription but PUMA and Bax transcription was significantly enhanced compared to non-damaged cells. In contrast, IR treatment triggered significant p21 mRNA synthesis in addition to PUMA and Bax mRNA production. While chromium treatment enhanced the binding of p53 and RNA polymerase II (RNA Pol II) to both the p21 and PUMA promoters, RNA Pol II elongation was only observed along the PUMA gene and not the p21 gene. In contrast, following IR treatment, RNA Pol II elongation was observed on both p21 and PUMA. Chromium-induced apoptosis therefore involves DNA-PK-mediated p53 activation followed by preferential transcription of pro-apoptotic PUMA over anti-apoptotic p21 genes.

Hypersensitivity to chromium-induced DNA damage correlates with constitutive deregulation of upstream p53 kinases in p21-/- HCT116 colon cancer cells.

The cyclin-dependent kinase inhibitor p21(CIP1/WAF1) is a key component in cell cycle control and apoptosis, directing an anti-apoptotic response following DNA damage. Chromium exposure resulted in a 500-1000 fold increase in apoptosis-induced cell death in p21-/- HCT116 cells compared to wild-type or p53-/- cells. p53 shRNA (or transient p53 siRNA) into p21-/- HCT116 cells reduced Cr(VI) sensitivity, suggesting the enhanced apoptosis in p21-/- cells is p53-dependent. Under non-DNA damage conditions, the p53 level in p21-/- cells was significantly higher than in wild-type cells, due to enhanced p53 phosphorylation and stabilization rather than elevated p53 transcription. Wild-type cells showed significant p53 protein induction upon DNA damage whereas p21-/- cells showed no p53 increase. p21-/- cells display the constitutive activation of upstream p53 kinases (ATM, DNA-PK, ATR, AKT and p38). 2D gel analysis revealed p53 patterns in p21-/- cells were distinct from those in wild-type cells before and after chromium exposure. Our results suggest that p21 has an important role in the cellular response to normal replicative stress and its absence leads to a "chronic DNA damage" state that primes the cell for p53-dependent apoptosis.